MONICA SAMUEL AVILA GRINBERG
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
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- Brazilian Society of Cardiology Guideline on Myocarditis-2022(2022) MONTERA, Marcelo Westerlund; MARCONDES-BRAGA, Fabiana G.; SIMOES, Marcus Vinicius; MOURA, Lidia Ana Zytynski; FERNANDES, Fabio; MANGINE, Sandrigo; OLIVEIRA JUNIOR, Amarino Carvalho de; SOUZA, Aurea Lucia Alves de Azevedo Grippa de; IANNI, Barbara Maria; ROCHITTE, Carlos Eduardo; MESQUITA, Claudio Tinoco; AZEVEDO FILHO, Clerio F. de; FREITAS, Dhayn Cassi de Almeida; MELO, Dirceu Thiago Pessoa de; BOCCHI, Edimar Alcides; HOROWITZ, Estela Suzana Kleiman; MESQUITA, Evandro Tinoco; OLIVEIRA, Guilherme H.; VILLACORTA, Humberto; ROSSI NETO, Joao Manoel; BARBOSA, Joao Marcos Bemfica; FIGUEIREDO NETO, Jose Albuquerque de; LUIZ, Louise Freire; HAJJAR, Ludhmila Abrahao; BECK-DA-SILVA, Luis; CAMPOS, Luiz Antonio de Almeida; DANZMANN, Luiz Claudio; BITTENCOURT, Marcelo Imbroise; GARCIA, Marcelo Iorio; AVILA, Monica Samuel; CLAUSELL, Nadine Oliveira; JR, Nilson Araujo de Oliveira; SILVESTRE, Odilson Marcos; SOUZA, Olga Ferreira de; MOURILHE-ROCHA, Ricardo; KALIL FILHO, Roberto; AL-KINDI, Sadeer G.; RASSI, Salvador; ALVES, Silvia Marinho Martins; FERREIRA, Silvia Moreira Ayub; RIZK, Stephanie Itala; MATTOS, Tiago Azevedo Costa; BARZILAI, Vitor; MARTINS, Wolney de Andrade; SCHULTHEISS, Heinz-Peter
- Survival of Heart Transplant Patients with Chagas' Disease Under Different Antiproliferative Immunosuppressive Regimens(2023) FURQUIM, Silas Ramos; GALBIATI, Luana Campoli; AVILA, Monica S.; MARCONDES-BRAGA, Fabiana G.; FUKUSHIMA, Julia; MANGINI, Sandrigo; SEGURO, Luis Fernando Bernal da Costa; CAMPOS, Iascara Wozniak de; STRABELLI, Tania Mara Varejao; BARONE, Fernanda; PAULO, Audrey Rose da Silveira Amancio de; OHE, Luciana Akutsu; GALANTE, Mariana Cappelletti; GAIOTTO, Fabio Antonio; BACAL, FernandoBackground: Chagas' disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas' disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown.Objectives: To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival.Methods: Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (""Change"" group). A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates.Conclusions: This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.
- Diretriz de Assistência Circulatória Mecânica da Sociedade Brasileira de Cardiologia(2016) AYUB-FERREIRA, Silvia Moreira; SOUZA NETO, Joao David de; ALMEIDA, Dirceu Rodrigues; BISELLI, Bruno; AVILA, Monica Samuel; COLAFRANCESCHI, Alexandre Siciliano; STEFANELLO, Bianca; CARVALHO, Braulio Matias de; POLANCZYK, Carisi Anne; GALANTINI, Danilo Ribeiro; BOCCHI, Edimar Alcides; CHAMLIAN, Eduardo Gregorio; HOJAIJ, Elaine Marques; GAIOTTO, Fabio Antonio; PINTON, Fabio Augusto; JATENE, Fabio Biscegli; RAMIRES, Felix Jose Alvarez; ATIK, Fernando Antibas; FIGUEIRA, Fernando; BACAL, Fernando; GALAS, Filomena Regina Barbosa Gomes; BRITO, Flavio de Souza; CONCEICAO-SOUZA, Germano Emilio; RIBEIRO, Gustavo Calado de Aguiar; PINHEIRO JUNIOR, Jairo Alves; SOUZA, Januario Manoel de; ROSSI NETO, Joao Manoel; LIMA, Jose Lindemberg da Costa; MEJIA, Juan Cosquillo; FERNANDES, Juliana Rolim; BAUMWORCEL, Leonardo; MOURA, Lidia Ana Zytynski; HAJJAR, Ludhmila Abrahao; BECK-DA-SILVA, Luis; ROHDE, Luis Eduardo Paim; SEGURO, Luis Fernando Bernal da Costa; PINHEIRO, Mabel Leite; PARK, Marcelo; FERNANDES, Marcelo Ramalho; MONTERA, Marcelo Westerlund; ALVES, Marco Stephan Lofrano; WANDERLEY JUNIOR, Mauro Rogerio de Barros; HOSSNE, Nelson; FERNANDES, Paulo Manuel Pego; LEMOS, Pedro; SCHNEIDEWIND, Rafael Otto; UCHOA, Ricardo Barreira; HONORATO, Ronaldo; MANGINI, Sandrigo; FALCAO, Sandra Nivea dos Reis Saraiva; LOPES, Sergio Augusto Veiga; STRABELLI, Tania Mara Varejao; GUIMARAES, Tereza Cristina Felippe; CAMPANILI, Ticiane Carolina Goncalves Faustino; ISSA, Victor Sarli
- 3rd Brazilian Directive on Cardiac Transplantation(2018) BACAL, Lemando; MARCONDES-BRAGA, Fabiana C.; ROHDE, Luis Eduardo Paim; XAVIER JUNIOR, Jose Leudo; BRITO, Flavio de Souza; MOURA, Lidia Ana Zytynski; COLAFRANCESCHI, Alexandre Siciliano; LAVAGNOLI, Carlos Fernando Ramos; GELAPE, Claudio Leo; ALMEIDA, Dirceu Rodrigues; GAIOTTO, Fabio Antonio; ATIK, Fernando Antibas; FIGUEIRA, Fernando Augusto M. S.; SOUZA, Germano Emilio Conceicao; RODRIGUES, Helcio; CAMPOS, Iascara Wozniak; SOUZA NETO, Joao David de; ROSSI NETO, Joao Manoel; GASPARETTO, Juliano; GOLDRAICH, Livia Adams; BENVENUTI, Luiz Alberto; SEGURO, Luis Fernando B. C.; ULHOA JUNIOR, Marcelo Boteiho; V, Maria da Consolacao Moreira; AVILA, Monica Samuel; CARNEIRO, Rodrigo; MANGINI, Sandrigo; FERREIRA, Silvia Moreira Ayub; STRABELLI, Tania Mara
- Bone Metabolism Impairment in Heart Transplant: Results From a Prospective Cohort Study(2020) SEGURO, Luis F. B. C.; PEREIRA, Rosa M. R.; SEGURO, Luciana P. C.; CAPARBO, Valeria F.; AVILA, Monica S.; MANGINI, Sandrigo; CAMPOS, Iascara W.; GAIOTTO, Fabio A.; MARCONDES-BRAGA, Fabiana G.; BACAL, FernandoBackground. Data on the prevention of fractures after heart transplant (HTx) are controversial in the literature. Understanding the effects of HTx on bone may guide appropriate treatments in this high-risk population. Methods. Seventy adult HTx patients were followed for 12 months. Clinical and laboratory parameters, bone mineral density, microarchitecture, and vertebral fractures were assessed at baseline (after intensive care unit discharge) and at 6 and 12 months. Patients received recommendations regarding calcium intake and vitamin D supplementation after HTx. Results. At baseline, 27% of patients had osteoporosis, associated with the length of hospitalization before HTx (P = 0.001). Bone mineral density decreased in the first 6 months, with partial recovery later. Bone microarchitecture deteriorated, mainly in the trabecular bone in the first 6 months and cortical bone in the subsequent 6 months. At baseline, 92.9% of patients had vitamin D levels <30 ng/mL and 20.0% <10 ng/mL. Patients also had calcium at the lower limit of normal, high alkaline phosphatase, and high bone resorption biomarker. These abnormalities were suggestive of impaired bone mineralization and normalized at 6 months with correction of vitamin D deficiency. The majority of vertebral fractures were identified at baseline (23% of patients). After multivariate analyses, only a lower fat mass persisted as a risk factor for vertebral fractures (odds ratio, 1.23; 95% confidence interval, 1.04-1.47; P = 0.012). Conclusions. High frequencies of densitometric osteoporosis, vitamin D deficiency, bone markers abnormalities, and vertebral fractures were observed shortly after HTx. Calcium and vitamin D supplementation should be the first step in correcting bone mineralization impairment before specific osteoporosis treatment.
- Early reduction of pulmonary arterial hypertension in patients using a long-term mechanical ventricular assistance device: a cross-sectional(2022) RANGEL, Bruno Soares da Silva; BISELLI, Bruno; QUINTANILHA, Nadia Romanelli; AVILA, Monica Samuel; PEGO-FERNANDES, Paulo Manuel; JATENE, Fabio Biscegli; KALIL FILHO, Roberto; FERREIRA, Silvia Moreira AyubBACKGROUND: Severe pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear. OBJECTIVE: To evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction. DESIGN AND SETTING: Cross-sectional study in a general hospital in Sao Paulo, Brazil. METHODS: This was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected. RESULTS: Four patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%. CONCLUSION: VAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.
- Emerging Topics in Heart Failure: Interventional Heart Failure Therapies(2020) ROSSI NETO, Joao Manoel; ALMEIDA, Dirceu Rodrigues de; ATIK, Fernando Antibas; AVILA, Monica Samuel; BONATTO, Marcely Gimenes
- Emerging Topics Update of the Brazilian Heart Failure Guideline-2021(2021) MARCONDES-BRAGA, Fabiana G.; MOURA, Lidia Ana Zytynski; ISSA, Victor Sarli; VIEIRA, Jefferson Luis; ROHDE, Luis Eduardo; SIMOES, Marcus Vinicius; FERNANDES-SILVA, Miguel Morita; RASSI, Salvador; ALVES, Silvia Marinho Martins; ALBUQUERQUE, Denilson Campos de; ALMEIDA, Dirceu Rodrigues de; BOCCHI, Edimar Alcides; RAMIRES, Felix Jose Alvarez; BACAL, Fernando; ROSSI NETO, Joao Manoel; DANZMANN, Luiz Claudio; MONTERA, Marcelo Westerlund; OLIVEIRA JUNIOR, Mucio Tavares de; CLAUSELL, Nadine; SILVESTRE, Odilson Marcos; BESTETTI, Reinaldo Bulgarelli; BERNADEZ-PEREIRA, Sabrina; JR, Aguinaldo F. Freitas; BIOLO, Andreia; BARRETTO, Antonio Carlos Pereira; JORGE, Antonio Jose Lagoeiro; BISELLI, Bruno; MONTENEGRO, Carlos Eduardo Lucena; SANTOS JUNIOR, Edval Gomes Dos; FIGUEIREDO, Estevao Lanna; FERNANDES, Fabio; SILVEIRA, Fabio Serra; ATIK, Fernando Antibas; BRITO, Flavio de Souza; SOUZA, Germano Emilio Conceicao; RIBEIRO, Gustavo Calado de Aguiar; VILLACORTA, Humberto; SOUZA NETO, Joao David de; GOLDRAICH, Livia Adams; BECK-DA-SILVA, Luis; CANESIN, Manoel Fernandes; BITTENCOURT, Marcelo Imbroinise; BONATTO, Marcely Gimenes; MOREIRA, Maria da Consolacao Vieira; AVILA, Monica Samuel; COELHO FILHO, Otavio Rizzi; SCHWARTZMANN, Pedro Vellosa; MOURILHE-ROCHA, Ricardo; MANGINI, Sandrigo; FERREIRA, Silvia Moreira Ayub; FIGUEIREDO NETO, Jose Albuquerque de; MESQUITA, Evandro Tinoco
- The first cardiac transplant experience in a patient with mucopolysaccharidosis(2012) GRINBERG, Henrique; QUAIO, Caio Robledo D'Angioli Costa; AVILA, Monica Samuel; FERREIRA, Silvia Moreira Ayub; VIEIRA, Marcelo Luiz Campos; BENVENUTI, Luiz Alberto; KIM, Chong Ae; BOCCHI, Edimar AlcidesHunter syndrome (MPSII) is a rare X-linked lysosomal storage disorder that can affect multiple systems but primarily affects the heart. We report the case of a previously asymptomatic 23-year-old patient who had an attenuated form of MPSII and presented with refractory heart failure that required a heart transplant. The diagnosis was confirmed by detection of an increase in urinary excretion of glycosaminoglycans, a deficiency in enzymatic activity, and molecular analysis. A myocardial biopsy revealed hypertrophic cardiomyocytes, mild fibrosis, and lysosomal storage in interstitial cells. Molecular analysis identified a novel mutation in the iduronate-2-sulfatase gene. Although the clinical outcome was not favorable, we believe that this approach may be valid in end-stage heart failure.
- Circulating miR-1 as a potential biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients(2017) RIGAUD, Vagner Oliveira-Carvalho; FERREIRA, Ludmila R. P.; AYUB-FERREIRA, Silvia M.; AVILA, Monica S.; BRANDAO, Sara M. G.; CRUZ, Fatima D.; SANTOS, Marilia H. H.; CRUZ, Cecilia B. B. V.; ALVES, Marco S. L.; ISSA, Victor S.; GUIMARAES, Guilherme V.; CUNHA-NETO, Edecio; BOCCHI, Edimar A.Cardiotoxicity is associated with the chronic use of doxorubicin leading to cardiomyopathy and heart failure. Identification of cardiotoxicity-specific miRNA biomarkers could provide clinicians with a valuable prognostic tool. The aim of the study was to evaluate circulating levels of miRNAs in breast cancer patients receiving doxorubicin treatment and to correlate with cardiac function. This is an ancillary study from ""Carvedilol Effect on Chemotherapy-induced Cardiotoxicity"" (CECCY trial), which included 56 female patients (49.9 +/- 3.3 years of age) from the placebo arm. Enrolled patients were treated with doxorubicin followed by taxanes. cTnI, LVEF, and miRNAs were measured periodically. Circulating levels of miR-1,-133b,-146a, and -423-5p increased during the treatment whereas miR-208a and -208b were undetectable. cTnI increased from 6.6 +/- 0.3 to 46.7 +/- 5.5 pg/mL (p<0.001), while overall LVEF tended to decrease from 65.3 +/- 0.5 to 63.8 +/- 0.9 (p=0.053) over 12 months. Ten patients (17.9%) developed cardiotoxicity showing a decrease in LVEF from 67.2 +/- 1.0 to 58.8 +/- 2.7 (p=0.005). miR-1 was associated with changes in LVEF (r=-0.531, p<0.001). In a ROC curve analysis miR-1 showed an AUC greater than cTnI to discriminate between patients who did and did not develop cardiotoxicity (AUC = 0.851 and 0.544, p = 0.0016). Our data suggest that circulating miR-1 might be a potential new biomarker of doxorubicin-induced cardiotoxicity in breast cancer patients.